LUIS GUSTAVO ABDALLA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
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- Stents for Bronchial Stenosis After Lung Transplantation: Should They Be Removed?(2015) FONESCA, H. V. S.; IUAMOTO, L. R.; MINAMOTO, H.; ABDALLA, L. G.; FERNANDES, L. M.; CAMARGO, P. C. L.; SAMANO, M. N.; PEGO-FERNANDES, P. M.Background. Airway complications after lung transplantation are the major cause of morbidity, affecting up to 33% of all cases. Bronchial stenosis is the most common complication. The use of stents has been established as the most effective therapy; however, their removal is recommended after 3-6 months of use. We have been using self-expandable stents as a definitive treatment and remove them only if necessary. For this report, we evaluated the use of self-expandable stents as a definitive treatment for bronchial stenosis after lung transplantation. Methods. We performed a retrospective cohort study to evaluate patients with bronchial stenosis from August 2003 to April 2014. Clinical and pulmonary function test data were collected. Results. Two hundred lung transplants were performed, 156 of which were bilateral. Sixteen patients experienced airway complications: 4 had dehiscence, 2 necrosis, and 10 bronchial stenosis. Of these patients, 7 had undergone bilateral procedures, and 2 patients developed stenosis in both sides. Twelve anastomotic stenoses were observed. The follow-up after stenting ranged from 1 to 7 years. All patients had increased lung function, and 4 remained stable with sustained increase in pulmonary function without episodes of infection. Three patients required removal of their prosthesis 6 months to 1 year after implantation because of complications. Two patients died owing to unrelated causes. Conclusions. Definitive treatment of bronchial stenosis with self-expandable stents is a viable option. The 1st year seems to be the most crucial for determining definitive treatment, because no patients required removal of their stent after 1 year.
- Stents for Bronchial Stenosis After Lung Transplantation: Should They Be Removed? (vol 47, pg 1029, 2015)(2015) FONSECA, H. V. S.; IUAMOTO, L. R.; MINAMOTO, H.; ABDALLA, L. G.; FERNANDES, L. M.; CAMARGO, P. C. L.; SAMANO, M. N.; PEGO-FERNANDES, P. M.
- Posterior Reversible Encephalopathy Syndrome in Lung Transplantation: 5 Case Reports(2014) ARIMURA, F. E.; CAMARGO, P. C. L. B.; COSTA, A. N.; TEIXEIRA, R. H. O. B.; CARRARO, R. M.; AFONSO JR., J. E.; CAMPOS, S. V.; SAMANO, M. N.; FERNANDES, L. M.; ABDALLA, L. G.; PEGO-FERNANDES, P. M.Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiologic entity characterized by typical neurologic symptoms with characteristic cerebral image alterations. It has been reported in solid organ transplantations, especially related to the use of calcineurin inhibitors. The incidence of PRES in lung transplantation is unknown and probably under-reported in the literature. Here we describe 5 cases of PRES after bilateral lung transplantation. One of the reported cases was the first in the literature in which the neurologic onset precluded the introduction of calcineurin inhibitor. Therefore, although calcineurin inhibitors are known to play an important role in the development of PRES in the setting of lung transplantation, other causes seems to be involved in the physiopathology of this syndrome.
- Technical Challenges in Lung Transplantation of Kartagener Syndrome Recipients: A Unique Team Experience With 12 Patients(2020) CASTRO, Caio Cesar Bianchi de; REIS, Flavio Pola dos; CARVALHO, Guilherme Vieira Soares de; FERNANDES, Lucas Matos; ABDALLA, Luis Gustavo; SAMANO, Marcos Naoyuki; AFONSO JUNIOR, Jose Eduardo; PEGO-FERNANDES, Paulo Manoel
- Tracheal Diverticulum as a Cause of Recurrent Infection in Post-Lung Transplant Patients: A Report of 2 Cases(2022) FORTUNATO, Hugo Garcia; REIS, Flavio Pola Dos; CASTRO, Bianchi Cesar Bianchi De; ABDALLA, Luis Gustavo; FERNANDES, Lucas Matos; PEGO-FERNANDES, Paulo ManuelBackground. Tracheal diverticulum (TD) is a rare entity in clinical practice, accidentally found by imaging methods. It is a potential factor for the development of chronic respiratory infections, contributing to the progression of preexisting lung diseases and putting the success of lung transplantation at risk.Objectives. This paper reports 2 cases of TD with atypical clinical presentation in post-lung transplant patients with recurrent infections and aims to present the importance of this differential diagnosis.Discussion. Case 1: A 30-year-old man with terminal lung disease underwent bilateral lung transplantation with a satisfactory postoperative period. He presented with TD as a focus of recurrent infection associated with persistent hemoptysis. Indicated for surgical resection (cervicotomy with resection of tracheal diverticulum), without complications. He evolved uneventfully in the postoperative period and was clinically stable at follow-up. Case 2: A 57-year-old woman with hypersensitivity pneumonia associated with secondary pulmonary arterial hypertension and bronchiectasis underwent bilateral lung transplantation without complications. She presented with TD as a focus of infection associated with esophageal symptoms. Indicated for the surgical approach (cervicotomy with resection of tracheal diverticulum), she was asymptomatic at follow-up.Conclusion. Conservative treatment is recommended in elderly and asymptomatic patients. Surgical resection is based on the recurrence of symptoms and failure of clinical therapy and is the preferred approach for reported cases.
- Abdominal Complications After Lung Transplantation in a Brazilian Single Center(2017) COSTA, H. F.; REIS, F. P. dos; GOMES-JUNIOR, O.; FERNANDES, L. M.; ABDALLA, L. G.; CAMPOS, S. V.; TEIXEIRA, R. H. O. B.; SAMANO, M. N.; PEGO-FERNANDES, P. M.Surgical and nonsurgical abdominal complications have been described after lung transplantation. However, there is limited data on this event in this population. The objective of this study was to analyze the incidence of abdominal complications in patients undergoing lung transplantation at the Heart Institute of the Faculty of Medicine, University of Sao Paulo (InCor-HCFMUSP) between the years 2003 and 2016. The main causes of abdominal complications were inflammatory acute abdomen (7 patients; 14%), obstructive acute abdomen (9 patients; 18%), gastroparesis (4 patients; 8%), distal intestinal obstruction syndrome (4 patients; 8%), perforated acute abdomen (7 patients; 14%), cytomegalovirus (CMV; 6 patients; 12%), and other reasons (12 patients; 26%). Separating these patients according to Clavien-Dindo classification, we had 21 patients (43%) with complications grade II, 4 patients (8%) with complications grade ilia, 7 patients (14%) with grade Illb complications, 7 patients (14%) with grade IV complications, and 10 patients (21%) with grade complications V. In conclusion, abdominal disorders are seriously increased after lung transplantation and correlate with a high mortality. Early abdominal surgical complication has worse prognosis.
- Abdominal Complications After Lung Transplantation in a Brazilian Single Center (vol 49, pg 878, 2017)Y(2017) COSTA, H. F.; REIS, F. P. dos; GOMES-JUNIOR, O.; FERNANDES, L. M.; ABDALLA, L. G.; CAMPOS, S. V.; TEIXEIRA, R. H. O. B.; SAMANO, M. N.; PEGO-FERNANDES, P. M.
- Fungal Infection by Mucorales Order in Lung Transplantation: 4 Case Reports(2014) NETO, F. M. F. D.; CAMARGO, P. C. L. B.; COSTA, A. N.; TEIXEIRA, R. H. O. B.; CARRARO, R. M.; AFONSO JR., J. E.; CAMPOS, S. V.; SAMANO, M. N.; FERNANDES, L. M.; ABDALLA, L. G.; PEGO-FERNANDES, P. M.Mucorales is a fungus that causes systemic, highly lethal infections in immunocompromised patients. The overall mortality of pulmonary mucormycosis can reach 95%. This work is a review of medical records of 200 lung transplant recipients between the years of 2003 and 2013, in order to identify the prevalence of Mucorales in the Lung Transplantation service of Heart Institute (InCor), Hospital das Clinicas da Universidade de Sao Paulo, Brazil, by culture results from bronchoalveolar lavage and necropsy findings. We report 4 cases found at this analyses: 3 in patients with cystic fibrosis and 1 in a patient with bronchiectasis due to Kartagener syndrome. There were 2 unfavorable outcomes related to the presence of Mucorales, 1 by reduction of immunosuppression, another by invasive infection. Another patient died from renal and septic complications from another etiology. One patient was diagnosed at autopsy just 5 days after lung transplantation, with the Mucor inside the pulmonary vein with a precise, well-defined involvement only of donor's segment, leading to previous colonization hypothesis. There are few case reports of Mucorales infection in lung transplantation in the literature. Surveillance for the presence of Mucor can lead to timely fungal treatment and reduce morbidity and mortality in the immunocompromised patients, especially lung transplant recipients.
- Incidence and Mortality by Cancer in Patients After Lung Transplantation in a Brazilian Institution(2017) SCHETTINI-SOARES, M.; JUNIOR, O. G.; COSTA, H. F.; FERNANDES, L. M.; ABDALLA, L. G.; CAMPOS, S. V.; TEIXEIRA, R. H. O. B.; SAMANO, M. N.; PEGO-FERNANDES, P. M.Background. The first human lung transplantation was performed by James Hardy in 1963 due to lung cancer. Currently, malignancy has its importance in the follow-up of transplanted patients because cancer risk is higher in this population and the main risk factor for this augmentation is immunosuppression. The most common types of cancer are non-melanoma skin cancer and post-transplantation lymphoproliferative diseases. The objective of this study is to measure the cancer incidence and its related mortality in lung-transplanted patients of a Brazilian institution. Methods. Review of the records of the 263 patients who underwent lung transplantation between April 2000 and April 2016 at the Heart Institute (InCor), focusing on the incidence of cancer, most common types of malignancies, and cancer mortality rate. We compared incidence and mortality with the International Society for Heart and Lung Transplantation (ISHLT) database. Results. During the 16-year period, the total incidence of cancer was 10.3% with 27 cases diagnosed in 21 patients. The most common types of cancer were non-melanoma skin cancer, prostate cancer, and post-transplantation lymphoproliferative diseases. Comparing the incidences after 1-year, 5-year, and 10-year follow-up with the ISHLT database, they were similar in the first two periods and higher in the third period. As to cancer mortality rate, it was similar to the ISHLT database in both periods analyzed. Conclusion. The incidence of malignancies was higher in our transplanted patients in comparison with the Brazilian population, and the most frequent types of cancer are in accordance with the literature, except for prostate cancer. Cancer mortality rate was similar to that from the ISHLT database.
- Lung Transplantation in Patients With Cystic Fibrosis(2013) SAMANO, M. N.; PEGO-FERNANDES, P. M.; RIBEIRO, A. K. Fonseca; TURACA, K.; ABDALLA, L. G.; FERNANDES, L. M.; CORREIA, A. T.; JATENE, F. B.Cystic fibrosis (CF) an autosomal recessive genetic disorder, affects many organs. The great majority of deaths occur due to respiratory failure after many years of chronic pulmonary infection. Despite recent progress in early detection by studies of genetic mutations and better understanding to treat nutritional and infectious states, lung transplantation is the CF treatment for most advanced cases. According to the International Society for Heart and Lung Transplantation (ISHLT) data, CF is the third most common reason for lung transplantation (16.8%) showing the best survival rate (60% at 5 years). We have described our experience in lung transplantation of CF patients between January 2000 and December 2011, reviewing medical charts of these patients were for gender, age, body mass index (BMI), comorbidities, disease duration, previous sputum gram stain, ischemic time, incidence of severe primary graft dysfunction (PGD Grade 3), intensive care unit (ICU) length of stay, and Kaplan-Meier survival. Among 150 lung transplantation, the 30 CF patients (20%) represented the second most common cause. The average age was 27.4 +/- 9.2 years, with a slight predominance of males (n = 16; 53.3%). The average BMI was 18.9 +/- 2.6. Most patients (60%) had pancreatic exocrine dysfunction. Also, 83.3% of patients showed a positive sputum culture for Pseudomonas, while Burkholderia cepacia was identified in only 4 patients (13.3%). The average time of the disease was 20.8 +/- 9.7 years. All transplantation were bilateral with an average ischemic time of 472 +/- 98.3 minutes and ICU length of stay of 9.9 +/- 6.3 days. The survival rates at 1 and 5 years were 92% and 77%, respectively, corresponding to the best outcomes among underlying diseases, comparable with other worldwide series and better than the ISHLT reports. CF, the second most common cause for lung transplantation among our cases, showed the best survival rate among all causes. Our survival rate was comparable with other reports.